Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service.

Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.

A telemedicine strategy to reduce waiting lists and time to specialist care: A retrospective cohort study.

INTRODUCTION: The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. METHODS: A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. RESULTS: The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls (p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group (n=14,403; 28.7%) than in the intervention group (n=16,387; 32.7%; p<0.001). DISCUSSION: Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.

[TeleOftalmo: strategy to expand the offer of ophthalmologic telediagnostics for primary healthcare in the Southern Brazil]. / TeleOftalmo: estratégia de ampliação da oferta de telediagnósticos oftalmológicos para a atenção primária à saúde no Sul do Brasil.

The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.

O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.

La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.

Transition of care of stable ischaemic heart disease patients from tertiary to primary care with telemedicine support: Randomized noninferiority clinical trial.

INTRODUCTION: Evidence of telehealth for chronic disease management is scarce and contradictory. OBJECTIVES: We aimed to evaluate the safety and efficacy of teleconsultations as support in the care transition of patients with stable coronary artery disease (CAD) from tertiary to primary care. METHODS: A randomized noninferiority clinical trial was undertaken in patients with CAD from a tertiary hospital in a middle-income country. Patients with functional angina class 1 or 2 and meeting discharge criteria were randomized to remain in the cardiology outpatient clinic for 12 months (control group, CG) or continue follow-up in a primary care unit with clinical support via telemedicine (intervention group, IG). The primary outcome was the maintenance of the functional angina class after 12 months. Secondary outcomes included control of risk factors and clinical outcomes. RESULTS: In total 271 patients (mean age, 66 years) were included; 81.1% and 91% of the IG and CG, respectively, maintained stable angina symptoms, thus noninferiority could not be shown between the groups. Regarding emergency room visits at 1 year, the IG (7.6%) was noninferior to the CG (6.0%) (absolute difference, 1.6%; noninferiority margin (NIM), -4.8% to 8.2%). For control of risk factors, 30.7% and 29.6% of the IG and CG, respectively, had blood pressure <130/80 mmHg (absolute difference, 1.1%; NIM, -10.5% to 12.8%), and 48.9% and 33.3% of diabetic patients in the IG and CG, respectively, had glycated haemoglobin <7% (absolute difference, 15.6%; NIM, -6.8% to 36%). CONCLUSIONS: In our study, the difference in the patients' angina functional class did not result in greater seeking of emergency care, supporting that discharge from the outpatient clinic with telemedicine is safe for patients with stable CAD treated at the tertiary level. The control of risk factors in these patients was noninferior to patients followed up in primary care. ClinicalTrials.gov (NCT02489565).

TeleOftalmo: estratégia de ampliação da oferta de telediagnósticos oftalmológicos para a atenção primária à saúde no Sul do Brasil / TeleOftalmo: strategy to expand the offer of ophthalmologic telediagnostics for primary healthcare in the Southern Brazil / TeleOftalmo: estrategia de ampliación de la oferta de telediagnósticos oftálmicos en la atención primaria de salud en el sur de Brasil

O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.

The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.

La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.

Social Distancing, Mask Use, and Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Brazil, April-June 2020.

We assessed the associations of social distancing and mask use with symptomatic, laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in Porto Alegre, Brazil. We conducted a population-based case-control study during April-June 2020. Municipal authorities furnished case-patients, and controls were taken from representative household surveys. In adjusted logistic regression analyses of 271 case-patients and 1,396 controls, those reporting moderate to greatest adherence to social distancing had 59% (odds ratio [OR] 0.41, 95% CI 0.24-0.70) to 75% (OR 0.25, 95% CI 0.15-0.42) lower odds of infection. Lesser out-of-household exposure (vs. going out every day all day) reduced odds from 52% (OR 0.48, 95% CI 0.29-0.77) to 75% (OR 0.25, 95% CI 0.18-0.36). Mask use reduced odds of infection by 87% (OR 0.13, 95% CI 0.04-0.36). In conclusion, social distancing and mask use while outside the house provided major protection against symptomatic infection.

Access and regulation of specialized care in Rio Grande do Sul: the RegulaSUS strategy of TelessaúdeRS-UFRGS. / Acesso e regulação ao cuidado especializado no Rio Grande do Sul: a estratégia RegulaSUS do TelessaúdeRS-UFRGS.

In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.

Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.

The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: The TeleOftalmo Project.

PURPOSE: To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. METHODS: We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. RESULTS: Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged ≥65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001). CONCLUSIONS: With telemedicine support, primary care physicians solved over two-thirds of patients' eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral.

Acesso e regulação ao cuidado especializado no Rio Grande do Sul: a estratégia RegulaSUS do TelessaúdeRS-UFRGS / Access and regulation of specialized care in Rio Grande do Sul: the RegulaSUS strategy of TelessaúdeRS-UFRGS

Resumo Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.

Abstract In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.

Prevalence and trends of mental disorders requiring inpatient care in the city of Porto Alegre: a citywide study including all inpatient admissions due to mental disorders in the public system from 2013-2017 / Prevalência e tendências temporais de transtornos mentais necessitando de tratamento de internação na cidade de Porto Alegre: um estudo de toda a cidade incluindo todas as internações por motivo de saúde mental no sistema público de 2013-2017

Abstract Objectives To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. Methods All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. Results There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. Conclusions Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

Resumo Objetivos Investigar a prevalência de 5 anos de pacientes internados no sistema público de saúde por motivo de saúde mental, estratificando-os por grupo etário e diagnóstico, e avaliar tendências temporais nas admissões nesse período em Porto Alegre. Métodos Todas as admissões no sistema público de saúde mental reguladas pelo sistema eletrônico da cidade, denominado Administração Geral dos Hospitais (AGHOS), foram incluídos na análise. A população total foi obtida a partir de estimativas da Fundação de Economia e Estatística (FEE). Informações gerais sobre a prevalência de 5 anos de admissões, tendências das séries temporais e prevalência por grupo etário e por diagnóstico foram apresentadas. Resultados Ocorreram 32.608 admissões no período de 5 anos analisado. A prevalência global de pacientes foi de 1,62% na população total, 0,01% em crianças, 1,12% em adolescentes, 2,28% em adultos e 0,93% em idosos. Os diagnósticos mais comuns foram relacionados ao uso de drogas, seguidos de transtornos de humor, relacionados ao álcool e transtornos psicóticos. Houve uma tendência linear mostrando um aumento no número de admissões de 2013 a meados de 2014, que caíram em 2015. Conclusões Admissões por transtornos mentais são relativamente comuns, principalmente entre adultos e relacionados ao uso de drogas e transtornos de humor. Tendências lineares variaram levemente nos últimos 5 anos. Estimativas de prevalência no mundo real podem ser úteis para formuladores de políticas interessados em planejar o sistema público de saúde mental em grandes cidades brasileiras.

Prevalence and trends of mental disorders requiring inpatient care in the city of Porto Alegre: a citywide study including all inpatient admissions due to mental disorders in the public system from 2013-2017.

OBJECTIVES: To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. METHODS: All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. RESULTS: There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. CONCLUSIONS: Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI / Telehealth as core of 21st century universal health care systems / Telesalud como eje organizacional de los sistemas de salud universales del siglo XXI

Novos desafios epidemiológicos e demográficos demandam novas formas de organizar os sistemas de saúde. O presente ensaio propõe a telessaúde como ferramenta organizativa, capaz de suavizar o triângulo de ferro da atenção à saúde e de facilitar a busca pelo triple aim, pelo seu potencial de aumento do acesso e qualidade com redução de custo. A integração da telessaúde ao processo de referência e transição entre serviços assistenciais aumenta a resolutividade da Atenção Primária à Saúde (APS), favorece a coordenação do cuidado, promove adesão terapêutica, diminui reinternações e estimula a prevenção quaternária. Este ensaio propõe a telessaúde como metasserviço que confere densidade tecnológica à APS e permite que ela se torne coordenadora efetiva do cuidado, passando a organizar o fluxo de informações, pessoas e insumos. Frente às inovações propostas, é essencial avaliar o impacto de ações já existentes de telessaúde para viabilizar a sua aplicação como metasserviço de saúde.

New epidemiological and demographic challenges require new ways of organizing healthcare systems. This essay proposes telehealth as an organizational tool, capable of smoothing the iron triangle of health care and facilitating achievement of the triple aim, namely greater access and quality with cost reduction. The integration of telehealth into the referral process and the transition between care services increases the resolvability of primary health care (PHC), facilitates the coordination of care, promotes treatment adherence, decreases readmissions, and stimulates quaternary prevention. This essay introduces the notion of telehealth as a meta-service that confers technological density to PHC and allows it to become an effective coordinator of care, organizing the flow of information, people and supplies. In view of the innovations proposed, it is essential to evaluate the impact of existing telehealth initiatives so as to extend their applicability as meta-service.

Nuevos desafíos epidemiológicos y demográficos demandan nuevas formas de organizar los sistemas de salud. El presente ensayo propone la telesalud como herramienta organizacional, capaz de suavizar el triángulo de hierro de la atención a la salud y de facilitar la búsqueda por el triple aim, por su potencial de aumento del acceso y calidad con reducción de costo. La integración de la telesalud al proceso de referencia y transición entre servicios asistenciales aumenta la capacidad resolutiva de la Atención Primaria a la Salud (APS), favorece la coordinación del cuidado, promueve la adhesión terapéutica, disminuye reinternaciones y estimula la prevención cuaternaria. Este ensayo propone la telesalud como metaservicio que confiere densidad tecnológica a la APS y permite que ella se convierta en coordinadora efectiva del cuidado, pasando a organizar el flujo de informaciones, personas e insumos. Frente a las innovaciones propuestas, es esencial evaluar el impacto de acciones ya existentes de telesalud para viabilizar su aplicación como metaservicio de salud.

Teleconsulta: nova fronteira da interação entre médicos e pacientes / Teleconsultation: new frontier of the interaction between doctors and patients / Teleconsulta: nueva frontera de la interacción entre médicos y pacientes

A teleconsulta, uma ação de telessaúde, apesar de ser regulamentada em vários países, ainda não é permitida no Brasil. O presente texto explora a situação da teleconsulta na América do Norte, na Europa e em outros países, fazendo um paralelo com a situação nacional dentro da medicina e de outras profissões da saúde. Ao final, por meio do referencial utilizado, é construída uma argumentação de forma a assumir um posicionamento favorável à regulamentação da teleconsulta no país.

Teleconsultation, a telehealth action, although regulated in several countries, is still not allowed in Brazil. This text explores the topic of teleconsultation in North America, Europe and other countries, parallel to the national reality in medicine and other health professions. Finally, from the theoretical framework analyzed, an argument is built to assume a favorable position to the regulation of teleconsultation in the country.

La teleconsulta, una acción de telesalud, a pesar de ser regulada en varios países, todavía no es permitida en Brasil. El presente texto explora el tema de la teleconsulta en América del Norte, en Europa y en otros países, haciendo un paralelo con la realidad nacional en la medicina y otras profesiones de la salud. Finalmente, a partir del marco teórico analizado, se construye una argumentación para asumir un posicionamiento favorable a la regulación de la teleconsulta en el país.

Effects of nurse telesupport on transition between specialized and primary care in diabetic patients: study protocol for a randomized controlled trial.

BACKGROUND: According to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics. METHODS: We designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up. DISCUSSION: We plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care. TRIAL REGISTRATION: Clinical Trials, NCT02768480 . Registered on 29 April 2016.

Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial.

BACKGROUND: Many Brazilian patients with complex diseases who are treated in tertiary referral clinics have been stable for long periods. The main needs of these patients involve monitoring of risk factors and review of drug prescriptions, which could be satisfactorily done in primary care facilities. The goal of this protocol is to evaluate the safety and effectiveness of telemedicine services to support the transition of patients with stable chronic coronary artery disease from the tertiary to the primary level of care. METHODS/DESIGN: We designed a randomized non-inferiority protocol that will include 280 patients with stable coronary artery disease (for at least 12 months). Patients will be selected from the Ischemic Heart Disease Clinic in a tertiary care hospital in southern Brazil. Enrolled participants will be randomized into one of two groups: 12 months of follow-up at the same clinic; or 12 months of follow-up at a primary care facility with clinical support from a telemedicine platform including a toll-free line for physicians (intervention group). In the intervention group, decisions to refer patients to tertiary care during follow-up will be made jointly by primary physicians and medical teleconsultants. The groups will be compared in terms of the primary outcome-maintenance of baseline functional class 1 or 2 after 12 months. Secondary outcomes include control of risk factors and instability of the disease. DISCUSSION: We intend to determine the effectiveness of using telemedicine to qualify the transition of patients with chronic coronary disease from the tertiary to the primary level of care. This should facilitate the access of patients to the healthcare system, since care will be provided closer to their homes, and provide more opportunities for treatment of severe cases at tertiary care hospitals that are often overcrowded. TRIAL REGISTRATION: ClinicalTrials.gov # NCT02489565 - trial registration date May 13, 2015.

Telehealth in Rio Grande do Sul, Brazil: Bridging the Gaps.

INTRODUCTION: In 1988, Brazil adopted a universal healthcare model in which access is mediated by the primary care level. However, difficulties have emerged in the coordination of care between the primary and specialized levels. Telehealth was thus proposed as a means to overcome this challenge. This article describes initiatives developed by a large Brazilian program, TelessaúdeRS/UFRGS, in the fields of teleconsultation, telediagnosis, tele-education, and information technology development to support the public healthcare system. MATERIALS AND METHODS: TelessaúdeRS/UFRGS was established in 2010 to develop a telehealth platform and a support system for primary care teams with a special focus on optimizing the flow between primary and specialized levels of care. To define priorities, TelessaúdeRS analyzes the health needs of the Brazilian population and the most common inquiries it receives from primary care health professionals. This information is then combined with the best available scientific evidence for development of services. RESULTS: Since 2010, over 50,000 clinical consultations have been provided. More than 15,000 healthcare professionals have benefited from teleconsultations and from telediagnosis and tele-education activities. All services were provided using information technology solutions developed by the Telessaúde team, including smartphone apps and a Web-based National Telehealth Platform. CONCLUSIONS: The case of TelessaúdeRS/UFRGS shows that even in the presence of structural limitations, telemedicine is potentially useful to improve the quality of care and streamline the flow between different levels of care.

Referring Quality Assessment of Primary Health Care for Endocrinology in Rio Grande do Sul, Brazil.

This paper presents results of an assessment of the quality research of endocrinology referrals in the public health system in the state of Rio Grande do Sul. From the analysis of 4,458 requests for endocrinology referrals, it was found that 15% of referrals had insufficient information for evaluation and 71% showed no clinical justification for authorization of referencing. The partial results of the study indicated that the lack of information makes it impossible to clinically regulate these requests. The use of referencing protocols associated with telemedicine tools can assist doctors in primary health care in the clinical management and make access to specialized services more equitable and timely.

Helicobacter pylori eradication in functional dyspepsia: HEROES trial.

BACKGROUND: Eradication of Helicobacter pylori in patients with functional dyspepsia continues to be a matter of debate. We studied eradication effects on symptoms and quality of life of primary care patients. METHODS: Helicobacter pylori -positive adult patients with functional dyspepsia meeting the Rome III International Consensus criteria were randomly assigned to receive omeprazole, amoxicillin trihydrate, and clarithromycin, or omeprazole plus placebo for 10 days. Endoscopy and H pylori tests were performed at screening and at 12 months. Outcome measures were at least 50% symptomatic improvement at 12 months using a validated disease-specific questionnaire (primary end point), patient global assessment of symptoms, and quality of life. RESULTS: We randomly assigned 404 patients (78.7% were women; mean age, 46.1 years); 201 were assigned to be treated with antibiotics (antibiotics group) and 203 to a control group. A total of 389 patients (96.3%) completed the study. The proportion of patients who achieved the primary outcome was 49.0% (94 of 192) in the antibiotics group and 36.5% (72 of 197) in the control group (P = .01; number needed to treat, 8). In the patient global assessment of symptoms, 78.1% in the antibiotics group (157 of 201) answered that they were better symptomatically, and 67.5% in the control group (137 of 203) said that they were better (P = .02). The antibiotics group had a significantly larger increase in their mean (SD) Medical Outcomes Study 36-Item Short Form Health Survey physical component summary scores than the control group did (4.15 [8.5] vs 2.2 [8.1]; P = .02). CONCLUSION: Helicobacter pylori eradication provided significant benefits to primary care patients with functional dyspepsia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00404534.

Erectile dysfunction and coronary artery disease: an association of higher risk in younger men.

INTRODUCTION: The association between erectile dysfunction (ED) and coronary artery disease (CAD) has been described in various settings, but it is unclear if there is an independent interaction with age. AIM: To investigate the interaction of age in the association between ED and CAD. METHODS: This case-control study was conducted among 242 patients referred for elective coronary angiography. One hundred fourteen patients with significant CAD were identified as cases and 128 controls without significant CAD. ED was evaluated by the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire, determined by a score ≤ 25 points. MAIN OUTCOME MEASURES: Significant CAD was based on stenosis of 50% or greater in the diameter in at least one of the major epicardial vessels or their branches. The analysis was conducted in the whole sample and according to the age strata, controlling for the effects of cardiovascular risk factors, testosterone, and C-reactive protein. Results. Patients had on average 58.3 ± 8.9 years. CAD and ED were associated exclusively in patients younger than 60 years (ED in 68.8% of patients with CAD vs. 46.7% of patients without CAD, P = 0.009). The association was independent of cardiovascular risk factors, testosterone and C-reactive protein (risk ratio 2.3, 95% confidence interval from 1.04 to 5.19). Severity of CAD was higher in patients younger than 60 years with ED. CONCLUSIONS: Men with less than 60 years of age who report ED presented a higher risk of having chronic CAD and more severe disease diagnosed by coronary angiography.

Considerações sobre a abordagem da mulher fumante pelo profissional de saúde / Considerations on the approach to women smokers by healthcare professionals

Há uma distinção significativa no tratamento de fumantes conforme o gênero, uma vez que a mulher tem uma série de barreiras adicionais que dificultam o abandono do cigarro. O objetivo deste trabalho é discutir a abordagem da paciente fumante. O tratamento do fumante tem como eixo fundamental a abordagem cognitivo-comportamental, com a finalidade de informá-lo sobre os riscos do tabagismo e benefícios de parar de fumar, motivá-lo e apoiá-lo nesse processo, fornecendo orientações para que possa lidar com a síndrome de abstinência, a dependência psicológica e os condicionamentos associados ao hábito de fumar. Essa abordagem pode ser apoiada por medicamentos que diminuem os sintomas da síndrome de abstinência. É importante determinar os níveis de dependência de cada fumante, o grau de motivação para abandonar o hábito de fumar, condições e tempo de exposição ao tabaco, bem como diferenciar as fases de experimentação ou de uso regular do cigarro, a fim de poder avaliaradequadamente o paciente e prepará-lo para deixar o fumo. Nessa abordagem,há cinco passos a serem seguidos: perguntar, avaliar, aconselhar, preparar e acompanhar.

Subtle, but significant distinctions exist in the treatment of smokers of bothgenders. When compared to men, women have some additional difficulties, which make quitting more of a challenge. The aim of this study is to discuss the approach of patients who smoke. Treatment of smokers is based fundamentally on a cognitive-behavioral approach, with the aim of informing them about the risks of smoking and the benefits of giving up, motivating and supporting them during the process of quitting, helping smokers deal with the abstinence syndrome, psychological dependence and the conditioning associated with the habit of smoking. It is important to determine the level of dependence for each smoker, the level of motivation for quitting, the conditions and duration (time period) of exposure to tobacco, as well as to differentiate between mere experimentationand regular cigarette use in order to adequately evaluate smokers and counsel them as best as possible, preparing them to abandon their habit, and following up after they have quit smoking. This approach can be supported by medications which reduce the symptoms of the abstinence syndrome. This cognitive-behavioraltreatment encompasses five steps (the five A´s): Asking, Assessing, Advising,Assisting and Arranging (follow-up).